Dr. Steve Miller is Senior Vice President & Chief Medical Officer of Express Scripts, the nation’s largest pharmacy benefit manager, and is a nationally recognized advocate for fair drug pricing. Dr. Miller talked to OBR about how payers are trying to balance the rising costs of cancer drugs with achieving benefit and value, and his company’s industry-first Oncology Care Value Program.

OBR: It isn’t news that spending on oncology drugs is increasing, but can you please provide your perspective on the magnitude of the issue.

SM: In 2015, spending on oncology medications filled under the pharmacy benefit increased nearly 24% from the previous year. Our 2016 reporting is being finalized, but looks to be coming in at around the same rate. Payers can expect to see spending in the category to increase 20% annually for next three years given the rich pipeline of targeted, oral, breakthrough oncology therapies in development.

In 2015, oncology was the third costliest specialty therapy class, costing payers $49.62 per member per year. I expect that this therapy class will move up higher in the rankings when we have our 2016 data fully analyzed.

OBR: Is oncology drug spending increasing equally amongst Medicare patients as it is for private insurance patients, or is there an imbalance in spending for these two types of cancer patients?

SM: It’s higher among the Medicare population. Per our 2015 Drug Trend Report, oncology medications were the costliest specialty therapy class for Medicare plans, with a cost of $275.73 per member per year. This represents an increase of nearly 32% over 2014, driven by a 17% increase in utilization, and a 14.7% increase in cost.

Protected drug class regulations within the Medicare benefit limit plans’ ability to manage spending more effectively in this class.

OBR: As an example of how you view the cancer space, are there any oncology therapeutics that really capture your attention as overpriced or overused given the benefit, and conversely are there particular cancer medications that seem to provide good benefit and good value?

SM: We have had many recent great breakthroughs in cancer. Targeted therapies can add months and years of life. Some new therapies harness the body’s own immune system to fight cancer. People are surviving cancer, but with that comes the need to be able to afford it.

Depending on the patient and their type of cancer, any one of the cancer therapies available on the market provides a good benefit and is a good value. But for a different patient with a different cancer, that same therapy may not deliver as good of an outcome or prolong life as much. In short, we’re paying top dollar for every indication, including indications where the outcomes for the patient are marginal.

So, what we are doing with our Oncology Care Value program is aligning the cost of the medication by indication, which enables varied drug price by efficacy and guarantees plan refunds for early discontinuation of treatment.

OBR: Please explain the role that Express Scripts plays in contributing to the delivery of quality cancer care. Can you provide us with some perspective on how Express Scripts is innovating in the oncology space, such as risk sharing with drug companies and the Oncology Care Value Program.

SM: As stated above, our industry-first Oncology Care Value Program aligns the cost of the medication by indication, and protects payers from unnecessary spending while ensuring patients are treated with the right drug for their condition at the right price.

While some oncology medications are indicated to treat multiple types of cancer, the cost of treatment may not align with its outcomes for various types of cancer. Additionally, some patients may not respond to therapy. As the country’s first program to factor these differences into value-based prescription drug payments, Express Scripts’ OCV Program will take a multi-faceted approach to align cost of treatment with its outcomes. The program focuses on prostate cancer, lung cancer, multiple myeloma and renal cell carcinoma, and includes medications that account for nearly a quarter of all oncology pharmacy spending.

In addition, the program leverages the specialization available through our Oncology Therapeutic Resource Center (TRC), which exclusively dispenses oncology medications. Patients begin therapy with clinically appropriate and cost-effective medication for a specific indication, and receive high-touch, personalized care from a team of nurses and pharmacists extensively trained in sub-specialties for oncology therapies. The Oncology TRC provides patients with specialized support from more than 200 patient care advocates, 80 specialist pharmacists and 60 nurses.

The program uniquely combines financial protections and clinical care to deliver optimal patient outcomes at a sustainable, affordable price.